Do you auscultate your NGs?

MunoRN, RN · Feb 17, 2015

We auscultate but only to help determine if we're ready to confirm placement with imaging. If nothing is going to be put down it then it doesn't require imaging confirmation, although that's pretty rare that we won't be putting anything down it. For short term ventilation we might not put anything down it, but even then we usually make sure the OG is in before we get a CXR for ET tube placement so it includes the OG as well.

AJJKRN · Feb 18, 2015

My facility has recently (in the last two years) implemented that when the NG is placed then a KUB is done and read by an MD verifying placement. If it's for decompression and stomach contents are being expelled we just flush the tube every 4 hours with 30cc NS and go on about our buisiness. If it's used for feeding/meds (which tube feeding really never happens but we do at times give meds such as barium, etc - for feeding we would have placed a Dobhoff or g/j tube instead) then we have to check the pH each time before giving anything through the tube. Is this similar to your practice?

Carpediem1012, BSN, RN · Feb 18, 2015

Interesting! I am still a student, but seem to place a lot of NGs meant for feeding/med admin. We are taught auscultation is not a reliable placement verifier and yet many of my well respected instructors still use the practice (hence my choice to research the topic). I am interested to hear other responses. Thank you :).

MunoRN, RN · Feb 18, 2015

It's not unheard of for instructors to be going off of old standards, and the move towards making imaging confirmation an absolute requirement for putting something down a tube is relatively recent.

nuangel1, BSN, RN · Feb 18, 2015

we auscultate when its placed .nurse places them.then we get cxr for md to confirm.

nurseprnRN, BSN, RN · Feb 18, 2015

There's a huge thread about this very subject (and it's always a good idea to do a search before you post a question, just in case). It's at

https://allnurses.com/nursing-student-assistance/checking-g-tube-891563.html

The definitive, evidence-based answer:

Correct placement of nasogastric tubes is critical for patient safety, and pH testing offers an evidence-based method to assist in this process (Tho PC, Mordiffi S, Ang E, Chen H. Implementation of the evidence review on best practice for confirming the correct placement of nasogastric tube in patients in an acute care hospital. Int J Evid Based Healthc. 2011;6:51–60. doi: 10.1111/j.1744-1609.2010.00200.x. [PubMed][Cross Ref])

Please also see the National Guidelines Clearinghouse, National Guideline Clearinghouse | Gastric tube placement verification.

Conclusion and recommendations about initial gastric tube (GT) placement bedside verification methods in the emergency department:

Auscultation as a single verification method is unreliable in determining GT placement (Not recommended).
There is insufficient evidence to support the use of carbon dioxide detection methods as a single GT placement bedside verification method(Level C: Weak).
There is insufficient evidence to support the use of transillumination and magnetic detection methods along with equipment and laboratory setting limitations (Level C: Weak).
There is sufficient evidence to support pH testing of GT aspirates as a component of a multiple method bedside verification approach (Level B: Moderate).

JustBeachyNurse, LPN · Feb 18, 2015

There's a huge thread about this very subject (and it's always a good idea to do a search before you post a question, just in case). It's at
https://allnurses.com/nursing-student-assistance/checking-g-tube-891563.html
The definitive, evidence-based answer:
Correct placement of nasogastric tubes is critical for patient safety, and pH testing offers an evidence-based method to assist in this process (Tho PC, Mordiffi S, Ang E, Chen H. Implementation of the evidence review on best practice for confirming the correct placement of nasogastric tube in patients in an acute care hospital. Int J Evid Based Healthc. 2011;6:51â€“60. doi: 10.1111/j.1744-1609.2010.00200.x. [PubMed][Cross Ref])

Please also see the National Guidelines Clearinghouse, National Guideline Clearinghouse | Gastric tube placement verification.

Conclusion and recommendations about initial gastric tube (GT) placement bedside verification methods in the emergency department:

Auscultation as a single verification method is unreliable in determining GT placement (Not recommended).
There is insufficient evidence to support the use of carbon dioxide detection methods as a single GT placement bedside verification method(Level C: Weak).
There is insufficient evidence to support the use of transillumination and magnetic detection methods along with equipment and laboratory setting limitations (Level C: Weak).
There is sufficient evidence to support pH testing of GT aspirates as a component of a multiple method bedside verification approach (Level B: Moderate).

I was always taught air insufficient. Aspirate, check pH plus radiology verification. On a regular basis confirm before feeds/meds aspirate & check pH. In school I was taught if radiological confirmation not available (such as off hours in a non-hospital facility), aspirate and pH is gold standard for checking placement bedside.

OneDuckyRN · Feb 18, 2015

I auscultated a dobhoff last week, heard bubbling in the stomach, and the X-ray said it was in the right lung base. Oops!

So no, I tend not to trust auscultation either...

KelRN215, BSN, RN · Feb 18, 2015

Since I was in nursing school (started in '02), I have been taught that auscultation is insufficient to verify placement. I never auscultate NG tube placements. When I worked in the hospital, we verified placement by pH. If we couldn't get anything back to test, the patient went down for an XR. If we confirmed with pH, the patient didn't need an XR.

Carpediem1012, BSN, RN · Feb 18, 2015

You know I love you GreenTea, but I did not want to "search" out an answer, but instead see what is currently being done. As you have stated in your well said post, there is a lot of EBP on the subject. I am interested I hearing what nurses are still doing in their practice. Many (according to aacn) do not know that auscultation is not best practice. I thought it would be interesting to see the responses.

nurseprnRN, BSN, RN · Feb 18, 2015

You could find a lot more data in that thread in addition to the ones you harvest here.